Facet joint injection in case of foramina stenosis; technique and my logic, lumbar spine скачать в хорошем качестве

Facet joint injection in case of foramina stenosis; technique and my logic, lumbar spine

Today, I will share a clinical practice of facet joint injection in case of foraminal stenosis. She has relieved her radicular pain with this protocol for a long time. However, she did not show any response to the conventional transforaminal steroid injection. I think you would find this weird. Is it crazy to do facet joint injection in case of foraminal stenosis? Usually, we choose transforaminal or epidural injection in case of foraminal stenosis or radicular pain, not facet joint injection. Likewise, we prefer facet joint injection or medial branch block technique in case of facet joint pain. I will introduce facet joint injection in case of foraminal stenosis. I will explain my logic how it works. It is the serial sagittal T2WI of MRI, and sorry for the poor quality of the image. I should have shown an oblique sagittal image, but it is not mine. It shows foraminal stenosis at the right L3-4,4-5, especially at the L4-5 level. Here is my logic In the narrowed tunnel, you will face a technical difficulty to put the needle in the foraminal space. The extruded black disc and swelled nerve root will be the obstacle. Also, delivering and staying enough steroids in the narrow foraminal space is almost impossible in severe foraminal stenosis. The facet joint is formed at the posterior border of the foraminal space. The superior recess and anterior capsule are neighboring to the foraminal space. Many degenerative facet joints are communicated to the epidural and foraminal space. And in turn, steroids in the facet joint will flow to the epidural space. The steroid in the joint space can stay longer than transforaminal steroids. How can steroids work in the intact joint capsule? The lymphocytes engulfing steroids migrate and show an anti-inflammatory effect on the foraminal space. The sensory nerve terminals of the facet joints pass the neurotransmitters through the medial branch to the dorsal root ganglion and dorsal horn. The sensory nerve terminal is an absorption target point of botulinum toxin of the facet joint. The botulinum toxin absorbed in the sensory nerve terminal will be transported to the ganglion and dorsal horn. So, the botulinum toxin achieves analgesic action at the same level at the dorsal root ganglion and spinal cord. If you missed this video, please review it. Then, you will understand my logic of facet joint injection of botulinum toxin in spinal stenosis. I will start from the C arm AP view Let me turn the C- arm to the right ipsilateral oblique view. let me clean the surgical site one more. Before facet joint injection, I will administer steroids into the L4 infraneural space. I will introduce the needle very carefully. It is very often to puncture the disc in the severely protruded disc. AP view The contralateral oblique view to measure the needle depth. Contrast medial injection on AP view I will administer steroid mixture, which contains 50U of botulinum toxin, 30mg of triamcinolone. it is my main target, the right L4-5 facet joint. I will go from posterior inferior to superior direction targeting the inferior recess. let me turn to ipsilateral oblique C-arm view Contrast media. it is AP view with arthrogram I will administer a steroid mixture containing botulinum toxin. Next target is the right L3-4 facet joint, I can not observe the clear inferior margin of the facet joint on AP view, so I turn to the ipsilateral oblique c arm view and approach. Contrast media injection. It is a facet joint arthrogram on AP view Let me administer steroid mixture. #PracticalPainManagement #spinalintervention #imageguided #learning #imagetrain #GE #Ziehm #MSK #chronicpain #case #lecture #cervical #lumbar #knee #elbow #noninvasive #painfree #ISURA #paindiploma #montpellier #madi #precise #decisionmaking #limethasone #dexamethasone #palmitate #이미지트레이닝 #만성통증 #통증 #초음파시술 #초음파 #시술 #안전한시술